Neutropenic Sepsis

Important: Therapy

• Prompt diagnosis is vital to allow early rationalisation of treatment.
• Take blood (2 sets - 20mL per set) and urine cultures before starting treatment, plus swabs from any other focus of infection, e.g. sputum, wound etc
• Treat if neutrophil count <0.5 x 10⁹/L or <1.0 and falling.
• Do not wait for FBC to confirm neutropenia - start treatment if suspected.
• Follow local protocols.
• All haematology patients (all lymphomas, leukaemias and myelomas) should be treated as high risk
• Patients should be assessed within 15 minutes and antibiotics given as soon as possible, within 1 hour of diagnosis of sepsis.

Notes:

Important: Therapy

 IV Piperacillin / tazobactam 4.5g 6 hourly

Notes:

Important: Therapy

IV Piperacillin / tazobactam 4.5g 6 hourly

plus

Gentamicin^# IV (Hartford Regimen) as per guideline

Use calculator

Notes:

Review the need for ongoing gentamicin on a daily basis according to severity.

^#Consider aztreonam IV as an alternative to gentamicin for patients with CrCl ≤20ml/min

Aztreonam must be used with caution in patients with immediate hypersensitivity to penicillins or cephalosporins.

Aztreonam dosing:

CrCl 10 – 20ml/min - 2g loading dose then 1g 4 times daily

CrCl <10ml/min       - 2g loading dose then 500mg 4 times daily

• Aztreonam does not provide the same antimicrobial spectrum cover as gentamicin.
• Aztreonam does not provide gram-positive cover.

Important: Therapy

In Mild penicillin allergy

IV Ceftazidime 2g 8 hourly

In severe penicillin allergy

IV Meropenem 1g 8 hourly

(only if benefits of treatment outweigh the risk of severe allergy)

Notes:

Important: Therapy

In mild penicillin allergy:

IV Ceftazidime 2g IV 8 hourly

plus

Gentamicin^# IV (Hartford Regimen) as per guideline

Use calculator

In severe penicillin allergy

Meropenem 1g 8 hourly

(only if benefits of treatment outweigh the risk of severe allergy)

Notes:

In mild penicillin allergy, review the need for ongoing gentamicin on a daily basis according to severity. 

^#Consider aztreonam IV as an alternative to gentamicin for patients with CrCl ≤20ml/min

Aztreonam must be used with caution in patients with immediate hypersensitivity to penicillins or cephalosporins.

Aztreonam dosing:

CrCl 10 – 20ml/min - 2g loading dose then 1g 4 times daily

CrCl <10ml/min       - 2g loading dose then 500mg 4 times daily

• Aztreonam does not provide the same antimicrobial spectrum cover as gentamicin.
• Aztreonam does not provide gram-positive cover (if staphylococcal infection suspected, seek advice from microbiology).

Important: Therapy

IV Meropenem 1g 8 hourly

Notes: